Patient access to antivirals - as highlighted in the CMO alert, at this stage the antiviral medications, Tamiflu® (Oseltamivir) or Relenza® (Zanamivir) are only indicated for supply on the NHS, for individuals who are suspected to have influenza on clinical grounds and on travel or contact history. Seasonal influenza finished circulating in the UK several weeks ago. Health Protection Units (HPUs) have access to supplies of antivirals that are to be used in the initial mitigation steps for individuals who comply with the details described in the Health Protection Agency algorithm. The location of local Health Protection Units can be found here.

The Emergency Preparedness Division (EPD) of the Department of Health are monitoring stock levels in conjunction with the Health Protection Agency and are ready to support HPUs with central stocks if this is considered necessary.

Supply of oseltamivir liquid (15mg/ml) - designated NHS hospital pharmacy manufacturing units will be manufacturing oral oseltamivir solution (15mg/ml) from the active ingredient, which DH has stockpiled.  The solution is for the treatment of children under the age of one. Until these arrangements are in place (which should be soon), commercially available Tamiflu® (oseltamivir) suspension will be available through HPUs. 

Advice that can be given to patients at this time - pharmacists should use their role as trusted healthcare professionals to provide simple, high quality information to worried patients and members of the public. The advice should enforce good practice guidance related to respiratory and hand hygiene:

Travellers to affected areas are advised to consult a doctor immediately if they show signs of flu-like symptoms. The confirmed cases of swine influenza virus infection have presented with symptoms of influenza-like illness: fever, respiratory tract illness, headache and muscle aches. In addition, some have presented with vomiting and diarrhoea. 

People returning from a visit to an affected area are advised to monitor their health closely for seven days. If during this period they develop a feverish illness accompanied by one or more of a cough, sore throat, headache or muscle aches, they should stay at home and contact their GP by phone or seek advice from NHS Direct.

It is important that at this pandemic alert level (5), the HPA algorithm has been followed before antivirals are supplied. This is because the HPU must be aware of all patients who may have, or be at risk of having, swine flu and be able to test and monitor whether they are in fact carrying the virus. Therefore,  should patients present in community pharmacies with NHS prescriptions for antivirals - recognising you may neither have any stock nor be able to access supplies from wholesalers - it is recommended that patients are referred back to the prescriber. In the main patient access to antivirals at this stage is through HPUs following discussion with the GP, who has assessed the patient. 

Future supplies of antivirals - should the state of alert be increased or the situation change, supply of antivirals may change to local Antiviral Collection Points (ACPs). Community pharmacies and hospitals may be identified by their local PCTs, to be an ACP. In these situations, the supply of antivirals, including the oral oseltamivir solution for use in children under one year, will be made available to the ACPs /hospitals via the PCT, who will receive the supply from the DH stockpile.

Securing the medicines supply chain - it is important, that pharmacists whether in a community or hospital setting adhere to normal ordering patterns and avoid stock piling any medicines. Steps are being taken nationally to secure antibiotics that may be required for secondary infections in the short term and to strengthen the supply chain in general for the longer term. 

All pharmacists should continue to show due care for the on-going treatment of their patients by continuing to act responsibly and professionally in maintaining stocks of medicines  for their patients. Failure to do so, for example by entering into arrangements or agreements which reduce the volume of medicines in the UK medicines supply chain, could compromise the ability of the NHS to respond appropriately to this situation, as well as potentially adversely affecting individual patient care and health.